Tumor

Key Radiographic Findings
1-Cortical destruction, 2-Periostitis, 3-Zone of transition

  • Benign:
    1-No cortical destruction
    2-Benign periostitis: thick wavy, uniform or dense = low-grade chronic irritation
    3-Narrow zone of transition; can be traced with a pencil
  • Malignant:
    1-Cortical destruction
    2-Aggressive periostitis: lamellated (onion-skinned), amorphous, sunburst
    3- Wide zone of transition; imperceptible
  • Permeative lesions (multiple small holes): not easily categorized as benign vs malignant: multiple myeloma, primary lymphoma of bone, Ewing's sarcoma

See BoneTumor.org for Tumor info

Metastatic Bone Disease

  • Bickels J, JBJS 2009;91A:1503
  • Biermann S, JBJS 2009;91A:1518

Syndromes

  • Mazabraud Syndrome: fibrous dysplasia and intramuscular myxomas. Rarely can develop osteosarcoma. (Crawford EA, JBJS 2009;91A:955
  • Klippel-Trenaunay Syndrome: rare congenital disorder characterized by the triad of cutaneous capillary malformation, varicose veins, and hypertrophy of bone and soft tissue (Kihiczak GG, Int J Dermatol 2006;45:883).
  • Morquio Disease (MPS IV): autosommal-recessive defect in the activity of one of two enzymes, N-acetylgalactosamine-6-sulfate (MPS-IVA_ or beta-galactosidase (MPS IVB); results in the accumulation of keratan sulfate and chondroitin-6 sulfate (Montano AM, J Inherit Metab Dis 2007;30:165).
  • Fibrodysplasia Ossificans Progressiva: rare; disabling autosomal dominant disorder of joint malformation and progressive heterotopic ossification caused by a recurrent missense point mutation in activin receptor IA (ACVRI / ALK2 / a BMP type I receptor). (Moore R, JBJS 2009;91A:1497).

Lipoma

  • MRI:homogenous with density of subcutaneous fat on all sequences.No enhancement
  • Treatment  =marginal excision.

Aneurysmal bone cysts

  • frequently occur in the first two to three decades of life
  • pain and a slow-growing lesion.
  • Xray= expansile lesion with septae or striations.
  • Treatment = curettage and grafting of the lesion.

Osteomyelitis

  • xray = typically shows lucency of bone, periosteal reaction, and a permeative pattern

Giant cell tumor of the tendon sheath

  • often arises from the synovial lining of tendon sheaths
  • frequently found in the hand and foot.  Slow growing but can invade adjacent structures. 
  • Treatment = excision

Giant cell tumor

  • epiphysis of long bone
  • xray = radiolucent lesion with a small rim of reactive bone.
Neurilemoma (Schwannoma)
  • benign tumor of nerve sheath (Schwann cell) origin
  • solitary, well-encapsulated lesion located on the surface of a peripheral nerve.
  • Treatment = excision without damaging the underlying nerve
Neurofibroma
  • spindle cell tumor arising within a peripheral nerve.  Invasive
  • Due to its location, it can interfere with distal nerve function
  • solitary or multiple 
  • von Recklinghausen's disease.
  • Treatment = resection which requires removal of the affected nerve with resultant distal nerve dysfunction

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